Florida State University Libraries Undergraduate Research Honors Ethical Issues and Life Choices (PHI2630) 2013 Why Euthanasia and Physician-Assisted Suicide are Morally Permissible Kelly Crocker Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] Crocker 1 Kelly Crocker Why Euthanasia and Physician-Assisted Suicide are Morally Permissible Key words: euthanasia, physician-assisted suicide, moral, ethic, bioethics Abstract: Although there has been much debate about the immorality or moral permissibility of physician-assisted suicide and euthanasia separately, there is little discussion encompassing both debates together. I argue in favor of the moral permissibility of these two topics. The major arguments addressed include some that are frequently addressed such as models of correct use of physician-assisted suicide, quality of life, and individual rights, as well as a few that arguments that have gotten little to no attention such as the utilitarian argument of less suffering and a thought experiment comparing the common euthanization of animals to the controversial euthanization of humans. I next address the major objections that opponents of physician- assisted suicide and euthanasia claim, these include: corruption of the doctor’s role as a healer, slippery slope and fear of abuse, and that there are alternatives to euthanasia. Lastly, I respond to these objections with further evidence to support my claim that these acts are morally permissible. The aim of this paper is to make a comprehensive argument in favor of physician- assisted suicide and euthanasia, which are frequently addressed in separate debates. Crocker 2 There has been much argument as to whether physician-assisted suicide and euthanasia are immoral or morally permissible, I will argue that physician-assisted suicide, in which a doctor prescribes a lethal dose of medication to a patient upon their request so that they may end their life, as well as voluntary active euthanasia, in which a doctor directly administers lethal drugs to the patient, are morally permissible and should be legalized. Acts of euthanasia are categorized as “voluntary”, “involuntary” and “non-voluntary.” Voluntary euthanasia is performed at the request of the patient. Involuntary euthanasia describes a situation in which euthanasia is performed without the patient’s request. Non-voluntary euthanasia relates to a situation in which euthanasia is performed when the patient is incapable of consenting (Bartels, 2010). Euthanasia is further categorized as active and passive. Active euthanasia refers to the deliberate act, usually through the intentional administration of lethal drugs, to end a patient’s life. Passive euthanasia is used to describe the deliberate withholding or withdrawal of life- prolonging medical treatment resulting in the patient’s death (Walsh, 2009). Passive euthanasia is accepted as morally permissible by much of the population because many see this as leaving the death of the patient to “God’s will”. Passive euthanasia has become an established part of medical practice and is relatively uncontroversial (Walsh, 2009). Critics argue that active euthanasia is not ethical because a doctor directly participates in the patient’s death. Considering that passive euthanasia is legal and is not seen as unethical, I will take the more radical argument in favor of voluntary active euthanasia. I will make several arguments in support of physician-assisted suicide and active voluntary euthanasia. Within both practices, the people who facilitate the process remain constant (the patient and the doctor together), the only difference between the two is who administers the drug, Crocker 3 the physician or the patient; I see this difference as irrelevant to my arguments. When I speak of euthanasia I am referring to active voluntary euthanasia unless otherwise noted and for the purposes of this paper, euthanasia is synonymous with physician-assisted suicide. I will also address several common objections to these practices. Plato recommended abandoning the sick people to death, the Hindus entrusted the elderly suffering patients to the Ganges River, and the elderly Eskimos exposed themselves to the cold when they became dependent on the community (Diaconescu, 2012). Euthanasia is not a modern manifestation but the idea was born along with human consciousness of suffering and death (Diaconescu, 2012). ARGUMENTS: Models of Correct Use For Physician-Assisted Suicide Although euthanasia is not legal in any states, physician-assisted suicide is currently legal in Oregon, Montana, Washington and Vermont. In the states of Oregon, Montana, Washington, and Vermont. Laws require that a physician diagnose a terminally ill patient as having a life expectancy of six months or less and a second doctor then must concur with the diagnosis (Worsnop, 1997). Patients must request the lethal prescription twice verbally and once in written form with a waiting period of at least two weeks between the first and last request (Worsnop, 1997). Lastly the doctor who writes the prescription must believe the patient is mentally competent to make the decision. The law also requires that patients be able to take the pills on their own (Worsnop, 1997). Further restrictions exist for the state of Vermont. Drugs have to be prescribed by doctors in Vermont for state residents only. Patient's request for drugs have to be witnessed by two impartial people who are not relatives or potential heirs, employees of health care facilities where the patient is being treated, nor the patient's doctor (Worsnop, 1997). The Crocker 4 trends occurring in these states can project what could transpire if physician-assisted suicide were legalized elsewhere, as well as allow a glimpse into what could happen if euthanasia was legalized. Oregon passed its Death with Dignity Act through a voter referendum in 1994 and started permitting the practice in 1998. Oregon has the lengthiest record of legal physician- assisted suicides so it is frequently used as research for the effects of legalization. The number of Oregonians who choose physician-assisted suicide has been slowly climbing; 673 cases were recorded between 1998 and 2012 and in 2012, the 77 cases reported to the Public Health Division amounted to about 0.2 percent of the total deaths recorded in the state (Worsnop, 1997). In Washington, where the law was established in 2009, 70 people took lethal doses of prescription medicine in 2011 (Worsnop, 1997). The number of individuals requesting the prescriptions is higher in both states, but in Oregon a little more than a third haven't used the drugs after obtaining them (Worsnop, 1997). “I think it's a peace-of-mind thing,” says Peg Sandeen, executive director of the Death with Dignity National Center. Assisted-suicide laws merely illuminate what has been going on in the shadows for years. Quality of Life: What is Life and is this Different than Living? What is the definition of life? Most medical professionals consider a human being alive if there is brain activity, however, I argue that being alive is different than living. Although someone may still be breathing and their brain may still be functioning, if their life is full of suffering without any hope of happiness, is that truly living? Living a full life is multifaceted but most would agree that autonomy is essential. A person’s ability to control their own body and do what they like, as long as it doesn’t harm anyone else, is crucial to the human existence. But what happens if a person can no longer do what they love? For example, hiking or even eating? What happens when loss of autonomy is taken to the extreme and they can no longer clean Crocker 5 themselves after use of the restroom or breathe without a machine? This loss of autonomy directly impacts the human sense of dignity. Critics argue that embarrassing matters such as this are simply a part of aging, however, terminally ill patients do not feel this way. According to statistics from the Public Health Division of Oregon, terminally ill patients who went through with physician-assisted suicide were asked what their end of life concerns were: 93.5% reported loss of autonomy, 92.5% reported that activities were no longer enjoyable, and 77.9% felt a loss of dignity. Individual Rights In the eyes of Oregon’s governor, former emergency room physician John Kitzhaber, the answer to the euthanasia controversy is simple: “I believe an individual should have control, should be able to make choices about the end of their life. As a physician, I can tell you that there's a clear difference between prolonging someone's life and prolonging their death,” (Worsnop, 1997). Most would agree that each person has the right to control what happens to his or her body and his or her life, then following this logic, why doesn’t this right carry over to the right to control how one dies? Values such as privacy, freedom, and autonomy are highly regarded in our society and are frequently protected and yet these rights are not applied to one of the most personal moments of a person’s life – death. Although these arguments are valid and thus used frequently, there are other arguments that receive little to no attention in the intellectual conversation about physician-assisted suicide and euthanasia. These arguments include the utilitarian argument of less suffering and comparing animal euthanasia to human euthanasia. The Utilitarian Argument: Less Suffering Jeremy Bentham made an argument for an innovative conception of morality, known as the Crocker 6 utilitarian approach, which is not about pleasing God or being faithful to theoretical rules, but rather is focused on increasing happiness and decreasing suffering as much as possible. The utilitarian approach would argue that euthanasia is morally acceptable because it decreases the misery of everyone involved: the patient, the caretakers, and the family and friends of the patient.